Establishing a learning healthcare system to improve health outcomes for people with epilepsy.

Affiliation

Donahue MA(1), Herman ST(2), Dass D(3), Farrell K(4), Kukla A(5), Abend NS(6), Moura LMVR(7), Buchhalter JR(8), Fureman BE(9).
Author information:
(1)Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States. Electronic address: [Email]
(2)Department of Neurology, Barrow Neurological Institute, Phoenix, AZ 85013, United States. Electronic address: [Email]
(3)Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States. Electronic address: [Email]
(4)Mission Outcomes Team, Epilepsy Foundation, Landover, MD 20785, United States. Electronic address: [Email]
(5)Mission Outcomes Team, Epilepsy Foundation, Landover, MD 20785, United States. Electronic address: [Email]
(6)Division of Neurology, Children's Hospital of Philadelphia & Departments of Neurology and Pediatrics, University of Pennsylvania, Philadelphia 19104, United States. Electronic address: [Email]
(7)Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States. Electronic address: [Email]
(8)Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada. Electronic address: [Email]
(9)Mission Outcomes Team, Epilepsy Foundation, Landover, MD 20785, United States. Electronic address: [Email]

Abstract

OBJECTIVE: To describe the organization of the Epilepsy Learning Healthcare System (ELHS), a network that aims to improve care outcomes for people with epilepsy (PWE). MATERIALS AND METHODS: Patients and family partners, providers, researchers, epidemiologists, and other leaders collaborated to recruit epilepsy centers and community services organizations into a novel learning network. A multidisciplinary Coordinating Committee developed ELHS governance and organizational structure, including four key planning Cores (Community, Clinical, Quality Improvement, and Data). Through Quality Improvement (QI) methodology grounded in the Institute for Healthcare Improvement (IHI) model, including iterative Plan-Do-Study-Act (PDSA) rapid learning cycles and other learning and sharing sessions, ELHS equipped epilepsy centers and community organizations with tools to standardize, measure, share, and improve key aspects of epilepsy care. The initial learning cycles addressed provider documentation of seizure frequency and type, and also screening for medication adherence barriers. Rapid learning cycles have been carried out on these initial measures in both clinical centers and community-based settings. Additional key measures have been defined for quality of life, screening, and treatment for mental health and behavioral comorbidities, transition from pediatric to adult care, counseling for women and girls living with epilepsy, referral for specialty care, and prevention and treatment of seizure clusters and status epilepticus. RESULTS: It is feasible to adopt a learning healthcare system framework in epilepsy centers and community services organizations. Through structured collaboration between epilepsy care providers, community support organizations, PWE, and their families/caregivers we have identified new opportunities to improve outcomes that are not available in traditional care models.